4.1 Glasgow Coma Scale

Case Study

A 43 year old divorced male, involved in a role over car crash, was not wearing a seat belt. Upon arrival at the local emergency room he was diagnosed with a traumatic brain injury. GlasgowComa Scale (GCS)was 6 but it was found to be 9 shortly afterward. RLA V.

Is the Glasgow Coma Scale as determined in the field predictive of outcome?

  1. Higher initial GCS scores tend to predict better recovery.
     
  2. However, prediction of prognosis and severity may be improved by considering the CT scan results and other factors.
     
  3. Hypoxia and hypotension can decrease the GCS; therefore, GCS values after resuscitation from cardiopulmonary insults are more specific.
     
  4. Sedative medicationscan decrease GCS values and should be used only after full neurologicalevaluation 1.
  • GCS has remained the most popular tool used to assess the level of consciousness for those who sustain a head injury 2.
     
  • Emergency service responders, the first on scene, are generally the first to assess an individual using the GCS. 
     
  • The GCS is used to decide what treatment protocols should be followed prior to the patient arriving at hospital. 
     
  • Even though the GCS has been shown to predict mortality and morbidity in the acute phase post injury, it remains unclear as to the GCS ability to predict functional outcomes during rehabilitation 3.